Results of liver retransplantations

Aim. To present the results of repeated liver transplantations performed in a federal center.  

Materials and methods. The results of 268 orthotopic full-liver postmortem transplantations in 248 patients since 1998 were analyzed. Retransplantation was performed in 20 patients (8.1%) – 10 men and 10 women, 18-64 years old (median age 44.4 years). The median MELD score was 21 (19-24). Observations before 2006 were analyzed retrospectively. Early hepatic artery thrombosis and late biliary complications due to insufficient arterial blood supply to the graft indicated the retransplantation in the majority of patients.  

Results. The duration of preservation stages was comparable to the primary transplantation. Significant differences were found in the duration of the anhepatic period, the volume of hemotransfusion, the duration of the surgery, the rate of complications and the hospital mortality rate. Currently, 9 of the 20 patients (45%) are alive, with a follow-up period of 7-140 months. Graft function was satisfactory in most recipients. Hospital mortality accounted for 35%.  

Conclusion. Liver retransplantation is accompanied by considerable technical difficulties, as well as by an increase in surgery duration, volume of blood transfusion, time of stay in the intensive care unit, and incidence of postoperative complications. Infectious complications were the main cause of death. With successful retransplantation, long-term results and survival rates were comparable to those of primary transplantation. 

1. Zarrinpar A., Hong J.C. What is the prognosis after retransplantation of the liver? Adv. Surg. 2012; 46: 87–100. https://doi.org/10.1016/j.yasu.2012.03.005.

2.

3. Rana A., Petrowsky H., Kaplan B., Jie T., Porubsky M., Habib S., Rilo H., Gruessner A., Gruessner R. Early liver retransplantation in adults. Transpl. Int. 2014; 27 (2): 141–151. https://doi.org/10.1111/tri.12201

4.

5. Bellido C.B., Martínez J.M.A., Gómez L.M.M., Artacho G.S., Diez-Canedo J.S., Pulido L.B., Acevedo J.M.P., Bravo M.A.G. Indications for and survival after liver retransplantation. Transplant. Proc. 2010; 42 (2): 637–640. https://doi.org/10.1016/j.transproceed.2010.02.017

6.

7. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004; 240 (2): 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

8.

9. Цирульникова О.М., Умрик Д.В., Милосердов И.А., Егорова Е.Т., Латыпов Р.А. Эффективность и безопасность препаратов прямого противовирусного действия у реципиентов печени с рецидивом хронического гепатита с 1-го генотипа после трансплантации. Вестник трансплантологии и искусственных органов. 2018; 20 (4): 61–68. https://doi.org/10.15825/1995-1191-2018-4-61-68 Tsiroulnikova O.M., Umrik D.V., Miloserdov I.A., Egorova E.T., Latypov R.A. The efficacy and safety of antiviral drugs of direct action in liver recipients with recurrence of chronic hepatitis C genotype 1 after transplantation. Russian Journal of Transplantology and Artificial Organs. 2018; 20 (4): 61–68. https://doi.org/10.15825/1995-1191-2018-4-61-68 (In Russian)

10.

11. Сюткин В.Е., Бессонова Е.Н., Давыденко М.Н. Терапия возвратного гепатита С после трансплантации печени препаратами прямого противовирусного действия: опыт трех российских центров. Эпидемиология и инфекционные болезни. 2018; 23 (1): 4–14. https://doi.org/10.18821/1560- 9529-2018-23-1-4-14 Syutkin V.E., Bessonova E.N., Davydenko M.N. Therapy of recurrent hepatitis C after transplantation of the liver with direct acting anti-hepatitis C virus drugs: experience of three Russian centers. Epidemiology and Infectious Diseases. 2018; 23 (1): 4–14. https://doi.org/10.18821/1560-9529-2018-23-1-4-14 (In Russian)

12.

13. Montano-Loza A.J., Bhanji R.A., Wasilenko S., Mason A.L. Systematic review: recurrent autoimmune liver diseases after liver transplantation. Aliment. Pharmacol. Ther. 2017; 45 (4): 485–500. https://doi.org/10.1111/apt.13894

14.

15. Новрузбеков М.С., Олисов О.Д. Сосудистые осложнения после ортотопической трансплантации печени. Транспланто логия. 2017; 9 (1): 35–50. https://doi.org/10.23873/2074- 0506-2017-9-1-35-50 Novruzbekov M.S., Olisov O.D. Vascular complications after orthotopic liver transplantation. Transplantologiya. 2017; 9 (1): 35–50. https://doi.org/10.23873/2074-0506-2017-9-1-35-50 (In Russian)

16.

17. Collins K.M., Doyle M.B.M., Chapman W.C. Orthotopic liver transplantation. In: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 2 Volume Set (Sixth Edition). 2017; 2: 1801– 1815. https://doi.org/10.1016/B978-1-4377-1454-8.00098-9

18.

19. Schielke A., Scatton O., Boelle P.-Y., Perdigao F., Bernard D., Soubrane O., Conti F. Ischemic-type biliary lesions: a leading indication of liver retransplantation with excellent results. Clin. Res. Hepatol. Gastroenterol. 2019; 43 (2): 131–139. https://doi.org/10.1016/j.clinre.2017.11.005.

20.

21. Hartog H., Hann A., Perera M.T.P.R. Primary nonfunction of the liver allograft. Transplantation. 2022; 106 (1): 117–128. https://doi.org/10.1097/TP.0000000000003682

22.

23. Takagi K., Domagala P., Porte R.J., Alwayn I., Metselaar H.J., van den Berg A.P., van Hoek B., Ijzermans J.N.M., Polak W.G. Liver retransplantation in adult recipients: analysis of a 38-year experience in the Netherlands. J. Hepatobiliary Pancreat. Sci. 2020; 27 (1): 26–33. https://doi.org/10.1002/jhbp.701

24.

25. Marudanayagam R., Shanmugam V., Sandhu B., Gunson B.K., Mirza D.F., Mayer D., Buckels J., Bramhall S.R. Liver retransplantation in adults: a single-centre, 25-year experience. HPB (Oxford). 2010; 12 (3): 217–224. https://doi.org/10.1111/j.1477-2574.2010.00162.x

26.

27. Lladó L., Lopez-Dominguez J., Ramos E., Cachero A., Mils K., Baliellas C., Busquets J., Fabregat J. Is liver retransplantation justified in the current era? Cir. Esp. 2021; 99 (5): 339–345. https://doi.org/10.1016/j.ciresp.2020.06.023

28.

29. Salimi J., Jafarian A., Fakhar N., Ramandi A., Behzadi M., Moeni A., Dashti H., Najafi A., Shariat M.R., Makarem J., Khamneh A.C. Study of re-transplantation and prognosis in liver transplant center in Iran. Gastroenterol. Hepatol. Bed. Bench. 2021; 14 (3): 237–242. PMID: 34221263; PMCID: PMC8245839